South Africa: AIDS Treatment Breakthrough (Reposted from sources cited below)
This posting contains a statement by the Treatment Action Campaign in South Africa applauding the South African Cabinet decision on a national anti-retroviral plan. Also included are the text of the cabinet statement, and a speech earlier this month in Durban by Stephen Lewis, the UN Special Envoy on HIV/AIDS in Africa. Lewis noted the overwhelming demand and momentum building around Africa to provide treatment to those who need it, regardless of the obstacles. He also noted that a breakthrough on this front in South Africa could provide enormous encouragement around the continent, and build pressure for donors as well to provide the needed resources.
The full report of the South African task force on which the Cabinet based its announcement, is available in PDF format at http://www.gov.za/reports/2003/ttr010803.pdf
The potential for additional obstacles, however, is apparent in a recent announcement by the South African Medicines Control Council (MCC) that they may prohibit use of nevirapine for prevention of mother-to-child-transmission because of alleged flaws in the studies confirming the drug's efficacy and safety. For more on this topic, see http://news.hst.org.za/view.php3?id=20030732 Webcasts from the South African AIDS Conference 2003, including transcripts of some sections, are available at: http://www.kaisernetwork.org/healthcast/sa-aids2003.
Treatment Action Campaign (TAC) http://www.tac.org.za
For Widest Distribution
TAC Response to Cabinet Statement
"DEVELOP AN ARV PLAN FOR THE PUBLIC SECTOR IN ONE MONTH"--CABINET INSTRUCTION WELCOMED BY THE TREATMENT ACTION CAMPAIGN
8 August 2003
There is cause for celebration and optimism. Government has decided to provide anti-retroviral therapy in the public sector in South Africa.
The Treatment Action Campaign (TAC) welcomes the Cabinet's instruction to the Department of Health to develop an operational plan within one month to provide ARVs in the public sector. The Cabinet endorsed the findings of the Joint Health and Treasury Task Team Report that between 500,000 and 1.7 million lives will be saved with anti-retroviral therapy. It also reaffirmed the science of HIV/AIDS pathogenesis and treatment.
This is a critical step to develop a more comprehensive treatment and prevention plan for managing the HIV/AIDS epidemic. Properly implemented, this will restore hope, dignity and life for millions of people in our country, and, hope throughout the continent. This will also give doctors, nurses and communities the opportunity to work together with government to build a better health care system that meets the needs of all people in South Africa.
The TAC National Executive will formally suspend the civil disobedience campaign and reconsider pending litigation early next week. We welcome Cabinet's bold step today but we also remember the anguish, pain and unnecessary loss of lives over the last four years.
The end of policy and political vacillation reveals the real hard work to all of us. TAC pledges to put its full weight and support behind the successful implementation of all interventions aimed at alleviating the HIV epidemic. We will work with government to save lives and build a better health service. The private sector, drug companies, civil society, international agencies and individuals need to redouble our efforts to improve prevention, treatment and care. We salute the efforts of every person living with HIV/AIDS, doctors, nurses, scientists, government administrators and all people who contributed to the report and the struggle for a treatment and prevention plan. Let's get to work!
[END OF TAC RESPONSE TO CABINET STATEMENT]
STATEMENT ON SPECIAL CABINET MEETING: ENHANCED PROGRAMME AGAINST HIV AND AIDS, 8 August 2003
Cabinet today convened in a special meeting to consider the Report of the Joint Health and Treasury Task Team on treatment options to enhance comprehensive care for HIV/AIDS in the public sector. A summary of the Report can be found on the government website, http://www.gov.za. The full Report will be posted on the website early next week.
The Report deals with various challenges, including in particular, a programme to administer anti-retrovirals to enhance the quality of life of those who have reached an advanced stage of the Syndrome, and it proposes various scenarios in dealing with this matter. The Report proceeds from the premise that new developments pertaining to prices of drugs, the growing body of knowledge on this issue, wide appreciation of the role of nutrition, and availability of budgetary resources do enable government to consider this enhanced response.
The meeting reiterated government's principled approach that antiretroviral drugs do help improve the quality of life of those at a certain stage of the development of AIDS, if administered properly.
Further, Cabinet noted that, as we consider details pertaining to this enhanced treatment programme, it is critical that we do not lower our guard as a nation, because there is no cure for AIDS.
It also noted the assertions in the Report that a primary challenge in our situation is to ensure that the 40 million South Africans who are not infected with HIV stay that way; and that those who are infected but have not as yet progressed to an advanced stage of AIDS lead a normal life through proper nutrition, healthy lifestyles and treatment of opportunistic infections. In other words, not everyone who is infected with HIV would need antiretroviral treatment.
Cabinet decided that the Department of Health should, as matter of urgency, develop a detailed operational plan on an antiretroviral treatment programme. The Department will be assisted in this work by South African experts as well as specialists from the Clinton Foundation AIDS Initiative who have not only offered to contribute to this effort; but have also been of great assistance in commenting on the work done thus far.
It is expected that this detailed work would be completed by the end of September 2003.
Government shares the impatience of many South Africans on the need to strengthen the nation's armoury in the fight against AIDS. Cabinet will therefore ensure that the remaining challenges are addressed with urgency; and that the final product guarantees a programme that is effective and sustainable.
8 August 2003
Issued by: Government Communications (GCIS)
[END OF CABINET STATEMENT]
Speech by Stephen Lewis
UN Special Envoy on HIV/AIDS in Africa
At the conference of the "Centre for the AIDS Programme of Research in South Africa" (immediately preceding the national South African AIDS Conference).
Durban, South Africa
August 3, 2003
[excerpts only; for full text see: http://www.sarpn.org.za/documents/d0000441/index.php]
I've been in this Envoy role for just over two years. The issues related to the pandemic ebb and flow, but remain much the same -- care, prevention, treatment, stigma, discrimination, gender, orphans, leadership--they all continue to reverberate, unceasingly, as we struggle to overcome HIV/AIDS.
At this moment in time, however, no one would dispute that the centerpiece of the debate is the quest for treatment. I recognize that the debate has controversial edges--witness the situation here in South Africa--but there's simply no denying that everywhere one goes on the African continent, everyone affected or infected by the virus is talking about or demanding treatment. And I mean everywhere. And at every level, from groups of women at village health clinics to the Presidents of countries. The change, even in two years, is startling. Suddenly there is the recognition, especially amongst People Living with HIV/AIDS, that treatment is possible, that it should be affordable, that lives are prolonged, and that treatment brings hope.
It is not just an idea whose time has come; it is a reality whose time is now.
Happily, the imperative of treatment is spreading non-stop across the African continent. At a recent breakfast, during the AU Summit in Maputo, chaired by President Obasanjo of Nigeria, and attended by the Secretary-General of the United Nations, the head of the Global Fund, Dr. Richard Feachem used the phrase that we are "on the verge of an explosion of treatment" throughout Africa. My experience suggests that Dr. Feachem is exactly right.
During 2002/2003, I had the opportunity of visiting a number of countries, all of which give credence to the powerful drive for treatment. In Mozambique, where I was last month, the combination of monies from the Global Fund and the Clinton Foundation is about to initiate widespread treatment; already Medicins Sans Frontieres has laid the groundwork with successful treatment regimens at pilot sites. In Malawi, an appraisal of the healthcare infrastructure by experts from WHO suggests the possibility of treating 50,000 people in the public sector in the relatively near future. ,,,In Zambia, the goal is to put 10,000 people into treatment as speedily as possible--indeed treatment has begun--using a grant from the Global Fund. In Kenya, the Government will use the force of a new regime and a new Minister of Health, to introduce treatment at the earliest date, relying initially on Global Fund dollars. In Nigeria, according to President Obasanjo, the country already has one of the most extensive public sector treatment programmes on the continent, using--as I can personally attest--generic antiretroviral drugs, purchased from India, and of course on the approved list of WHO antiretrovirals. I need hardly remind you of Botswana . everyone is surely familiar with their successful and concerted treatment programme.
Finally, I just returned yesterday from a four-day trip to Uganda. Uganda, as everyone knows, is the country which has had the greatest success in countering the pandemic. If ever there were lessons to be learned, they are to be learned from Uganda. I want to say, without any fear of contradiction, that the country is obsessed with treatment and is pursuing it single-mindedly. The approach is orchestrated by the Joint Clinical Research Centre, which offers the following information: there are well over a million people living with HIV/AIDS in Uganda; it is projected that some two hundred thousand would today qualify for treatment. Seventeen thousand are currently being treated through the public sector, civil society sector and private sector combined--and the target is to have sixty thousand in treatment by the end of next year, which would make it the largest public sector programme of its kind on the continent. They are not cowed by infrastructure. They are not cowed by human resource capacity. They are, quite simply, determined to keep their people alive.
Perhaps I can add an encouraging footnote. The Research Centre insists that the 17,000 people now in treatment has resulted in a significant increase in the numbers seeking voluntary counseling and testing. The Research Centre is persuaded that there is a direct cause and effect relationship between treatment and testing; that is, between treatment and prevention.
I could go on, but I trust the point is made. No matter how high the prevalence rate in individual countries; no matter how impoverished those countries may be; no matter how frayed the infrastructure, government after government across the continent is bent on treatment. They are answering the desperate call of the people living with AIDS; they are responding to the NGO activists; they are embracing the proposition that treatment prolongs life and treatment brings hope.
Nor is there any naivete in any of this. The countries fully recognize the tremendous task they face in strengthening health infrastructures, in replenishing human capacity, in developing laboratory technology, in training thousands upon thousands of health care professionals and community health workers. But nothing daunts them. Even the question of sustainability in the face of acute financial distress--put quite simply, unremitting poverty -- does not render them impotent. They are, in the words of President Moghae of Botswana, "fighting for survival", and survival does not brook delay. Happily, and this is true of almost every country, there is, either in the private sector or amongst NGOs like MSF, an increasing experience of antiretroviral treatment on a small scale ... sufficient to make governments confident that they have the rudimentary knowledge required to move to the large scale.
It's truly inspiring to see how determined these Governments are in the face of the state of their domestic economies and the hurdles which must be leaped. Allow me to state the obvious: in comparison with South Africa, they are grossly disadvantaged and their economies are reeling. ,,,
I'm not so presumptuous as to tell South Africa what to do. But I do feel compelled at this moment in time, when the press for treatment is all-consuming across this, the most afflicted continent, to make clear the position of those of us who work within the United Nations, or at the very least, to make my own position evident.
In so doing, I seek no confrontation. I have read the news reports: I recognize that there are South African Government studies on coverage, cost and sustainability which will soon be assessed by cabinet; I recognize that there have been broad signals that the many private sector and private hospital treatment initiatives now in place may soon be joined by a roll-out in the public sector. My only caveat would be that when people are dying, a signal is seldom sufficient. Speed and action become the sine qua non. And when the action finally happens, there will be an outpouring of relief and exhilaration throughout Africa, akin, for many, to the emotional catharsis which accompanied the end of apartheid. South Africa is one of the leaders on this continent. If there is a breakthrough here, every country will feel similarly encouraged. And there's one other factor that must be taken into account: from the donor community--World Bank, Global Fund, Clinton Foundation, international NGOs, United Nations agencies, bilateral development Ministries--I genuinely believe that resources will flow to sustain whatever South Africa undertakes. The world, overwhelmingly, wants South Africa to defeat the pandemic.
The welter of predictions, from the views of Professor Alan Whiteside to the recent World Bank study, are not just sobering, they are terrifying. I have read the World Bank study, cover to cover. It's not an easy read, because much of the text is turned over to algebraic equations which are, for this layperson, indecipherable. But then you look at the narrative portion of the text, and what it says about the prospects for South Africa is nothing less than apocalyptic. I remind you that the Bank is given to sober appraisal, dispassionate analysis, econometric configurations, guarded prophecies. For the Bank to predict the possibility of a failed state of South Africa within three generations, based on the socio-economic fall-out from HIV/AIDS, is astonishingly uncharacteristic. It must therefore be taken seriously. In truth, it doesn't surprise me. While it is pleasing and unusual to have the analysis of mortals confirmed by the World Bank, it was surely obvious, some time ago, that the methodical toll, year after year, exacted by AIDS would, cumulatively, cause the unraveling of whole societies. We've never given enough credence to that reality. It's good that the Bank has now done so.
But in a powerful way, it's the wrong reality. I, for one, am weary of hearing new justifications for intervention from the western world, or new reasons for declaring a state of emergency. It apparently isn't enough to have a human catastrophe; we have to couch it as a threat to international security; we have to imply potential destabilization so great as to spawn breeding grounds for terrorism; we have to wring our hands over the long-term economic consequences, damaging to investment, trade and growth, before we're moved to rescue the human condition.
What is wrong with the world? People are dying in numbers that are the stuff of science fiction. Millions of human beings are at risk. Communities, families, mothers, fathers, children are like shards of humanity caught in a maelstrom of destruction. They're flesh and blood human beings, for God's sake; is that not enough to ignite the conscience of the world? Why should we have to produce all these tortured rationales to drive home such an obvious point? This pandemic has done something dreadful to the instinct for compassion. I don't really understand what's happening; I don't really understand why the simple act of saving or prolonging a human life isn't sufficient anymore. It's irrational to need a balance sheet of geometric calculation and economic architecture. It's sick.
I was in Masaka District of Uganda just last Wednesday, where one lonely NGO is dealing with three thousand, six hundred people, men women and children, all of them HIV positive. Masaka was virtually ground zero of the pandemic in all of Africa. I was traveling with Ms Graca Machel, and when the people addressed us, right in the heartland of a rural community, they talked about hearing of drugs called anti-retrovirals, and they pleaded for the right to live. You really have to wonder what the world has wrought: there's something terribly degrading about people so ill, begging to stay alive. At least it can be said that the Government is desperately trying to respond to them. The day before, we were at the Mother-to-Child Plus clinic at Mulago Hospital in Kampala. That's the clinic where the mother and the infant are both on nevirapine to interrupt transmission of the virus, and where the mother, if her CD-4 count is below 200, can begin anti-retroviral treatment. We met a woman whose CD-4 count had dropped to 1 (yes, 'One'), and a month later, after ARVs, she was filled with buoyancy, energy and an inexhaustible lust for life. And her children aren't orphans because their mother is alive.
When Nelson Mandela spoke in Paris on July 15th, to the Conference on HIV Pathogenesis and Treatment, just in advance of the failed meeting in support of the Global Fund, he said, and I quote "The world must do more, much more on every front in the fight against AIDS. Of course, it means dramatically expanding our prevention efforts, but the most striking inequity is our failure to provide the lifesaving treatment to the millions of people who need it most . the single most important step we must now take is to provide access to treatment throughout the developing world. There is no excuse for delay. We must start now . If we discard the people who are dying from AIDS, then we can no longer call ourselves decent people".
That seems to me to say it all. But I don't want to end these remarks without acknowledging three things. First, my emphasis on treatment is not meant, in the slightest, to diminish the need for prevention. I well recognize that the two work, irreplaceably and inseparably, hand in hand. Second, the question of access to drugs in the post-Doha world, and their cost, is obviously critical, and I shall be addressing that issue later this month in advance of the WTO meeting in Cancun. Third, the question of resources remains central to everything else, and I have no illusions that that struggle over money is yet joined.
All of that notwithstanding, treatment is the current agenda. It will remain the current agenda until the agenda is met. As Nelson Mandela said: it is an elemental matter of human decency, and history will judge where decency was wanting.
Message-Id: <200308082106.h78L61H23541@marduk.africapolicy.org> From: "Africa Action" <email@example.com> Date: Fri, 8 Aug 2003 17:08:22 -0500 Subject: South Africa: AIDS Treatment Breakthrough